This application presents a career development plan in medical informatics bringing together the fields of informatics, health services research, and epidemiology to improve health and health care. [unreadable] CANDIDATE & CAREER GOALS: The applicant is formally trained in informatics, pediatrics, epidemiology, and health services research. She will work with an outstanding group of mentors and collaborators at the Yale Center for Medical Informatics, Yale-New Haven Hospital's Center for Outcomes Research & Evaluation, and the Dept. of Pediatrics to attain her goal of launching an independent research program using data from electronic health records (EHRs) to accurately measure and to improve health care. [unreadable] RESEARCH BACKGROUND: The Institute of Medicine has identified inadequate quality of care as a national problem. Improvements in quality and safety are needed not only for adults but also for pediatrics; however, efforts to improve care in pediatrics have lagged behind. Information from outpatient EHRs is ideal to inform these efforts to improve health care because they contain detailed data on medical encounters. However, since EHRs are not designed for population-based analyses and since much of their richness derives from the nuances available in narrative text, it is not straightforward to extract meaningful and accurate clinical data from them - therefore validation of measurements of care is critical. [unreadable] RESEARCH AIMS: Primary: To use patient-data from EHRs to develop a standardized approach to measuring indicators of quality and safety of care in real-time, to validate that approach, and to apply it to measuring specific pediatric indicators of care (create a "surveillance system for quality"). Secondary: To test generalizability of the approach developed by disseminating it to other EHR-users. PLAN: The plan is to develop an approach for measuring 7 indicators of pediatric care using EHR-data, to validate the approach, and to apply it across a network of sites that use the same widely-used EHR system. [unreadable] SIGNIFICANCE: The approach modeled in this work will build a critical foundation that can be extended to other clinical measurements including other indicators of quality and safety as well as to data for epidemiological and research studies. By developing a validated, applied approach and standardized definitions using informatics tools to measure key clinical indicators of quality and safety in real-time, the investigators will provide leadership in the utilization of information technology to impact clinical care. By accurately using EHR-data for studies of effectiveness of quality-improvement interventions, this innovation will drive clinical change and directly result in improved care. The relevance to public health is that the work will develop tools for improving quality of care and accessing electronic patient-data that can be used for surveillance and for interventions to improve health and health care. [unreadable] [unreadable] [unreadable] [unreadable] [unreadable] [unreadable] [unreadable]